The Wesley Hospital Urology Department, Brisbane, Australia.
School of Medicine, University of Queensland, Brisbane, Australia.
World J Urol. 2019 Jul;37(7):1263-1279. doi: 10.1007/s00345-018-2497-y. Epub 2018 Sep 25.
To review our experience with MRI-guided in-bore prostate biopsy (MRGB) and present a review of the literature on MRGB.
A retrospective review of patients presenting for MRGB between 2013 and 2018. Diagnostic and biopsy MRI scans were reviewed to collect data on scan dates, procedure times, characteristics of MRI targets (PI-RADS™ score, target size, ADC value and location). A review of the literature on MRGB for the period 2013-2018 was performed.
607 targets in 554 men were biopsied. Overall and significant cancer detection rate were 80% and 55% at a patient level, and 76 and 59% at the target level, respectively. Prostate cancer (CaP) detection in men with prior negative biopsy was 60% while 50% of men on active surveillance were upgraded to clinically significant disease (CSD). Lesion location did not predict for presence of CaP or CSD. PI-RADS™ score, age and PSAD were predictors of CSD at biopsy on multivariate analysis. Literature review identified 23 reports reporting on MRGB cohorts (~ 4000 patients). Overall cancer detection ranged from 23 to 74% and CSD in 63% overall. CaP detection in PI-RADS™ 3 targets was substantially lower in our series and the literature than for PI-RADS™ 4-5 targets.
MRGB in PI-RADS™ 3-5 targets yields high rates of cancer diagnosis. High detection rates are also seen in men with prior negative biopsy and AS cohorts. PI-RADS™ score, age and PSAD can reliably predict CSD detection. The number of published series is small and the role of MRGB in PI-RADS™ 3 targets needs further study.
回顾我们在磁共振引导下腔内前列腺活检（MRGB）方面的经验，并对 2013 年至 2018 年期间的 MRGB 文献进行综述。
对 2013 年至 2018 年间接受 MRGB 的患者进行回顾性分析。对诊断性和活检性 MRI 扫描进行回顾，以收集扫描日期、程序时间、MRI 靶标特征（PI-RADS 评分、靶标大小、ADC 值和位置）的数据。对 2013-2018 年期间的 MRGB 文献进行综述。
共对 554 名男性的 607 个靶标进行了活检。在患者水平上，总癌症检出率和显著癌症检出率分别为 80%和 55%，在靶标水平上分别为 76%和 59%。在有先前阴性活检的男性中，前列腺癌（CaP）检出率为 60%，而在主动监测的男性中，有 50%升级为临床显著疾病（CSD）。病变位置不能预测 CaP 或 CSD 的存在。多变量分析显示，PI-RADS 评分、年龄和 PSAD 是活检时 CSD 的预测因素。文献综述确定了 23 项报告 MRGB 队列（~4000 例患者）的报告。总体癌症检出率范围为 23%至 74%，CSD 检出率总体为 63%。在我们的系列和文献中，PI-RADS™3 靶标中的 CaP 检出率明显低于 PI-RADS™4-5 靶标。
PI-RADS™3-5 靶标中的 MRGB 可获得较高的癌症诊断率。在先前有阴性活检和 AS 队列的男性中，也观察到高检出率。PI-RADS 评分、年龄和 PSAD 可可靠预测 CSD 的检出。已发表的系列数量较少，MRGB 在 PI-RADS™3 靶标中的作用需要进一步研究。
